Did the organization have unrelated business gross income of $1,000 or more during the year from business activities

No

Initiation fees and capital contributions

$0

Gross receipts for public use of club facilities

$0

Reason for Public Charity Status (for 2011)

The organization is not a private foundation because it is:

An organization that normally receives: (1) more than 33 1/3 % of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions - subject to certain exceptions, and (2) no more than 33 1/3 % of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975

Support Schedule for Organizations Described in Section 509(a)(2) (for 2011)

2007 - 2011 Total

Total support

$251,399

Gifts, grants, contributions, and membership fees received

$0

Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose

$122,810

Tax revenues levied for the organization's benefit and either paid to or expended on its behalf

$0

The value of services or facilities furnished by a governmental unit to the organization without charge

$0

Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources and Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975

$0

Other

$128,589

Revenue, Expenses, and Changes in Net Assets or Fund Balances

2006

Total revenue

$26,119

Contributions, gifts, grants, and similar amounts received

$0

Contributions to donor advised funds

$0

Direct public support

$0

Indirect public support

$0

Government contributions (grants)

$0

Program service revenue including government fees and contracts

$23,096

Membership dues and assessments

$0

Interest on savings and temporary cash investments

$0

Dividends and interest from securities

$0

Net rental income or (loss)

$0

Gross rents

$0

Less: rental expenses

$0

Other investment income

$0

Gain or (loss) from sales of assets other than inventory

$0

Gross amount from sales of assets other than inventory

$0

Less: cost or other basis and sales expenses

$0

Net income or (loss) from special events and activities

$3,023

Gross revenue

$14,596

Less: direct expenses other than fundraising expenses

$11,573

Gross profit or (loss) from sales of inventory

$0

Gross sales of inventory, less returns and allowances

$0

Less: cost of goods sold

$0

Other revenue

$0

Total expenses

$27,330

Program services

$25,885

Management and general

$1,445

Fundraising

$0

Payments to affiliates

$0

Net assets or fund balances at end of year

$2,870

Excess or (deficit) for the year

$-1,211

Net assets or fund balances at beginning of year

$4,081

Other changes in net assets or fund balances

$0

Statement of Functional Expenses (for 2006)

Total

Program services

Management and general

Fundraising

Total functional expenses

$27,330

$25,885

$1,445

$0

Grants paid from donor advised funds

$0

Other grants and allocations

$0

Specific assistance to individuals

$0

Benefits paid to or for members

$0

Compensation of current officers, directors, key employees, etc.

$0

$0

$0

$0

Compensation of former officers, directors, key employees, etc.

$0

$0

$0

$0

Compensation and other distributions, not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B)

$0

$0

$0

$0

Salaries and wages of employees not included above

$0

$0

$0

$0

Pension plan contributions not included above

$0

$0

$0

$0

Employee benefits not included above

$0

$0

$0

$0

Payroll taxes

$0

$0

$0

$0

Professional fundraising fees

$0

$0

$0

$0

Accounting fees

$0

$0

$0

$0

Legal fees

$300

$0

$300

$0

Supplies

$85

$85

$0

$0

Telephone

$0

$0

$0

$0

Postage and shipping

$51

$0

$51

$0

Occupancy

$0

$0

$0

$0

Equipment rental and maintenance

$233

$233

$0

$0

Printing and publications

$153

$0

$153

$0

Travel

$146

$146

$0

$0

Conferences, conventions, and meetings

$0

$0

$0

$0

Interest

$0

$0

$0

$0

Depreciation, depletion, etc.

$0

$0

$0

$0

Other expenses not covered above

$26,362

$25,421

$941

$0

Balance Sheets

2006

Total assets

$2,870

Cash - non-interest-bearing

$2,870

Savings and temporary cash investments

$0

Accounts receivable less allowance for doubtful accounts

$0

Pledges receivable less allowance for doubtful accounts

$0

Grants receivable

$0

Receivables from current and former officers, directors, trustees, and key employees

$0

Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B)

Reconciliation of Revenue per Audited Financial Statements With Revenue per Return

2006

Total revenue

$0

Total revenue, gains, and other support per audited financial statements

$0

Other expenses

$0

Net unrealized gains on investments

$0

Donated services and use of facilities

$0

Recoveries of prior year grants

$0

Other

$0

Other revenue

$0

Investment expenses

$0

Other

$0

Reconciliation of Expenses per Audited Financial Statements With Expenses per Return

2006

Total expenses

$0

Total expenses and losses per audited financial statements

$0

Other revenue

$0

Donated services and use of facilities

$0

Prior year adjustments

$0

Losses

$0

Other

$0

Other expenses

$0

Investment expenses

$0

Other

$0

Current Officers, Directors, Trustees, and Key Employees

Total number of officers, directors, and trustees permitted to vote on organization business at board meetings

6

Are any officers, directors, trustees, or key employees listed in Form 990, Part V-A, or highest compensated employees listed in Schedule A, Part I, or highest compensated professional and other independent contractors listed in Schedule A, Part II-A or II-B, related to each other through family or business relationships?

No

Do any officers, directors, trustees, or key employees listed in Form 990, Part V-A, or highest compensated employees listed in Schedule A, Part I, or highest compensated professional and other independent contractors listed in Schedule A, Part II-A or II-B, receive compensation from any other organizations, whether tax exempt or taxable, that are related to the organization?

No

Does the organization have a written conflict of interest policy?

Yes

Other Information

Did the organization have unrelated business gross income of $1,000 or more during the year covered by this return, and has it filed a tax return on Form 990-T for this year?

No

Was there a liquidation, dissolution, termination, or substantial contraction during the year?

No

Is the organization related (other than by association with a statewide or nationwide organization) through common membership, governing bodies, trustees, officers, etc., to any other exempt or nonexempt organization?

No

Direct and indirect political expenditures

$0

Did the organization file Form 1120-POL for this year?

No

Were substantially all dues nondeductible by members?

Did the organization make only in-house lobbying expenditures of $2,000 or less?

Dues, assessments, and similar amounts from members

$0

Section 162(e) lobbying and political expenditures

$0

Aggregate nondeductible amount of section 6033(e)(1)(A) dues notices

$0

Taxable amount of lobbying and political expenditures

$0

Does the organization elect to pay the section 6033(e) tax on the amount above?

If section 6033(e)(1)(A) dues notices were sent, does the organization agree to add the amount above to its reasonable estimate of dues allocable to nondeductible lobbying and political expenditures for the following tax year?

Initiation fees and capital contributions

$0

Gross receipts for public use of club facilities

$0

At any time during the year, did the organization, directly or indirectly, own a controlled entity within the meaning of section 512(b)(13)?

No

Amount of tax imposed on the organization during the year under: section 4911

$0

Amount of tax imposed on the organization during the year under: section 4912

$0

Amount of tax imposed on the organization during the year under: section 4955

$0

Did the organization engage in any section 4958 excess benefit transaction during the year or did it become aware of an excess benefit transaction from a prior year?

No

Amount of tax imposed on the organization managers or disqualified persons during the year under sections 4912, 4955, and 4958

$0

Amount of tax above, reimbursed by the organization

$0

At any time during the tax year, was the organization a party to a prohibited tax shelter transaction?

No

Did the organization acquire a direct or indirect interest in any applicable insurance contract?

No

Did the supporting organization, or a fund maintained by a sponsoring organization, have excess business holdings at any time during the year?

No

Number of employees employed in the pay period that includes March 12, 2006

0

Analysis of Income-Producing Activities (for 2006)

Unrelated business income

Excluded by section 512, 513, or 514

Related or exempt function income

Business code

Amount

Exclusion code

Amount

Total

$0

$3,023

$23,096

Program service revenue

Program service revenue 1

000000

$0

00

$0

$23,096

Program service revenue 2

000000

$0

00

$0

$0

Program service revenue 3

000000

$0

00

$0

$0

Program service revenue 4

000000

$0

00

$0

$0

Program service revenue 5

000000

$0

00

$0

$0

Medicare/Medicaid payments

000000

$0

00

$0

$0

Fees and contracts from government agencies

000000

$0

00

$0

$0

Membership dues and assessments

000000

$0

00

$0

$0

Interest on savings and temporary cash investments

000000

$0

00

$0

$0

Dividends and interest from securities

000000

$0

00

$0

$0

Net rental income or (loss) from real estate

debt-financed property

000000

$0

00

$0

$0

not debt-financed property

000000

$0

00

$0

$0

Net rental income or (loss) from personal property

000000

$0

00

$0

$0

Other investment income

000000

$0

00

$0

$0

Gain or (loss) from sales of assets other than inventory

000000

$0

00

$0

$0

Net income or (loss) from special events

000000

$0

Income from an activity that is not regularly carried on (section 512(a)(1))

Did the organization make any taxable distributions under section 4966?

No

Did the organization make a distribution to a donor, donor advisor, or related person?

No

The total number of donor advised funds owned at the end of the tax year

$0

The aggregate value of assets held in all donor advised funds owned at the end of the tax year

$0

The total number of separate funds or accounts owned at the end of the tax year (excluding donor advised funds included above) where donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts

$0

The aggregate value of assets held in all funds or accounts included above at the end of the tax year

$0

Reason for Non-Private Foundation Status

The organization is not a private foundation because it is

Organization that normally receives: less than 1/3 of its support from gross investment income and unrelated taxable business income and more than 1/3 of its support from contribution, membership fees

Support Schedule

2005

Total

$0

Gifts, grants, and contributions received

$0

Membership fees received

$0

Gross receipts from admissions, merchandise sold or services performed, or furnishing of facilities in any activity that is related to the organization's charitable, etc., purpose

$0

Gross income from interest, dividends, amounts received from payments on securities loans (section 512(a)(5)), rents, royalties, and unrelated business taxable income (less section 511 taxes) from businesses acquired by the organization after June 30, 1975

$0

Net income from unrelated business activities not included above

$0

Tax revenues levied for the organization's benefit and either paid to it or expended on its behalf

$0

The value of services or facilities furnished to the organization by a governmental unit without charge. Do not include the value of services or facilities generally furnished to the public without charge

$0

Other income

$0

Lobbying Expenditures by Electing Public Charities (for 2006)

Total exempt purpose expenditures

$0

Total lobbying expenditures

$0

Total lobbying expenditures to influence public opinion (grassroots lobbying)

$0

Total lobbying expenditures to influence a legislative body (direct lobbying)

$0

Other exempt purpose expenditures

$0

Lobbying nontaxable amount

$0

Grassroots nontaxable amount

$0

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